The public health implications of the increasing predominance of Schistosoma mansoni in Egypt: a pilot study in the Nile delta.

Over the past twenty years, Schistosoma mansoni has apparently replaced Schistosoma haematobium as the more prevalent species of schistosomiasis in the Nile delta. In this paper we show that this change has profound implications for public health strategies, in particular the provision and utilization of diagnostic and treatment services for the Egyptian rural population, and for health education programmes. The processes of providing and seeking treatment for the two forms of schistosomiasis are quite distinct as they have different signs and symptoms and are diagnosed in stool and urine samples respectively. In two Nile delta villages, where S. mansoni has almost completely replaced S. haematobium, we found that health services were geared primarily to S. haematobium, and hence many cases of S. mansoni remain undiagnosed and untreated. One reason for this is that health unit staff and local people lacked detailed knowledge of the two forms of schistosomiasis, indicating the need for health education.